Organization
UPSIDE TO YOUTH DEVELOPMENT L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT EDWARD GAY JR. (CHIEF EXECUTIVE OFFICER)
(804) 943-0629
Entity
Organization
Contact information
Practice address
9401 COURTHOUSE RD STE 300, CHESTERFIELD, VA 23832-6686
(804) 205-1011
(804) 479-8175
Mailing address
9401 COURTHOUSE RD STE 300, CHESTERFIELD, VA 23832-6686
(804) 205-1011
(804) 479-8175
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM2800X
Methadone Clinic
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
Other
Enumeration date
07/23/2007
Last updated
03/21/2023
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